What could explain the late emergence of COVID-19 in Africa?

Abstract

At the end of November 2019, a novel coronavirus responsible for respiratory tract infections emerged in China. Despite drastic containment measures, this virus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread in Asia and Europe. The pandemic is ongoing with a particular hotspot in southern Europe and America in spring 2020. Many studies predicted an epidemic in Africa similar to that currently seen in Europe and the USA. However, reported data do not confirm these predictions. Several hypotheses that could explain the later emergence and spread of the coronavirus disease 2019 (COVID-19) pandemic in African countries are being discussed, including the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs.

Keywords: Africa; antimalarial drugs; coronavirus disease 2019; malaria; severe acute respiratory syndrome coronavirus 2.

Fig. 1

Confirmed cases of COVID-19 by country (4 June 2020). The colour gradient (dark to light) represents the graduated number of confirmed cases (highest to lowest). The figure was generated by compiling the data on COVID-19 cases on 4 June 2020, in each country worldwide (from Worldometer [124]).

Fig. 2

Comparison of the cumulative total COVID-19 deaths reported in the first 200 days of the pandemic in the USA, Brazil, France, Italy and the most affected countries in Africa (South Africa, Algeria, Nigeria, Cameroon, Senegal, Ghana, Kenya and Ethiopia). (a) Cumulative deaths for the 12 selected countries, (b) cumulative deaths for the eight African countries, (c) cumulative deaths for the 12 selected countries in log. The number of deaths was evaluated every 10 days from the first SARS-CoV-2 detected case to 18 August 2020, in each country. The graph was generated with daily WHO data [12]. (d) cumulative deaths for the eight selected countries in log.

Fig. 2

Comparison of the cumulative total COVID-19 deaths reported in the first 200 days of the pandemic in the USA, Brazil, France, Italy and the most affected countries in Africa (South Africa, Algeria, Nigeria, Cameroon, Senegal, Ghana, Kenya and Ethiopia). (a) Cumulative deaths for the 12 selected countries, (b) cumulative deaths for the eight African countries, (c) cumulative deaths for the 12 selected countries in log. The number of deaths was evaluated every 10 days from the first SARS-CoV-2 detected case to 18 August 2020, in each country. The graph was generated with daily WHO data [12]. (d) cumulative deaths for the eight selected countries in log.

Fig. 3

Global distribution of the two most used artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated falciparum malaria in 2018, especially artemether-lumefantine and artesunate-amodiaquine, the most deployed ACT in malaria endemic countries. The figure was generated by compiling the data obtained by WHO in 2018 [117].

Fig. 4

Number of artemisinin-based combination therapy (ACTs) used in 2018, by malaria-affected country. The colour gradient (dark to light) depends on the graduated number of ACTs used (highest to lowest). The figure was generated by compiling the data obtained by WHO in 2018 [117].